Customer Requirement Questionnaire

Coil Replacement Company’s application engineers will assist you in determining the solution for your application. Take a few minutes to complete this form, and we will respond in one business day or less.

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Contact Information

* denotes required information for pricing

First Name *

Last Name *

Company Name

Street Address

City

State

Zip Code

Country

Phone Number *

Email Address *

Current Customer? *

Yes

Existing Coil Information

* denotes required information for pricing

Manufacturer

Model Number

Quantity

Protective / Anti-Corrosive Coating?

Please Attach Drawings/Pictures

Specifications & Requirements

* denotes required information for pricing

Coil Type *

Number of Rows *

Tube Material

Tube Diameter

Tube Wall Thickness

Turbospirals

Fin Material

Fin Corrugation Options

Fin Thickness

Casing Material

Connection Material

Connection Size

Header Material

Circuitry

Protective Coating

Add Freeze Block Technology?

Type of Fluid Being Circulated

Quantity

Custom Dimensions

* denotes required information for pricing

Fin Height *

Fin Length *

Fins Per Inch *

Casing Height

Casing Length

Casing Depth